Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR LESION FL FACE/NECK

Professional

Both

$250.00

Service Code	HCPCS 00075
Hospital Revenue Code	990
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$175.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: UMR Bronson Commercial	$115.00

PR LESION REMOVAL COLONOSCOPY

Professional

Both

$1,553.00

Service Code	HCPCS G6024
Min. Negotiated Rate	$621.20
Max. Negotiated Rate	$1,087.10
Rate for Payer: BCBS Complete	$621.20
Rate for Payer: Cash Price	$1,242.40
Rate for Payer: Priority Health Cigna Priority Health	$1,087.10
Rate for Payer: UMR Bronson Commercial	$714.38

PR LESION SINGLE

Professional

Both

$35.00

Service Code	HCPCS 00073
Hospital Revenue Code	990
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$24.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: UMR Bronson Commercial	$16.10

PR LEUPROLIDE ACETATE /3.75 MG

Professional

Both

$1,081.00

Service Code	HCPCS J1950
Min. Negotiated Rate	$432.40
Max. Negotiated Rate	$1,611.54
Rate for Payer: Aetna Commercial	$1,611.54
Rate for Payer: BCBS Complete	$432.40
Rate for Payer: BCBS Trust/PPO	$1,111.82
Rate for Payer: Cash Price	$864.80
Rate for Payer: Cash Price	$864.80
Rate for Payer: Priority Health Cigna Priority Health	$756.70
Rate for Payer: UMR Bronson Commercial	$497.26

PR LEUPROLIDE ACETATE INJECITON

Professional

Both

$37.00

Service Code	HCPCS J9218
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$25.90
Rate for Payer: Aetna Commercial	$14.16
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: BCBS Trust/PPO	$13.04
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90
Rate for Payer: UMR Bronson Commercial	$17.02

PR LEUPROLIDE ACETATE SUSPNSION

Professional

Both

$452.00

Service Code	HCPCS J9217
Min. Negotiated Rate	$180.80
Max. Negotiated Rate	$316.40
Rate for Payer: Aetna Commercial	$186.74
Rate for Payer: BCBS Complete	$180.80
Rate for Payer: BCBS Trust/PPO	$191.56
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cash Price	$361.60
Rate for Payer: Priority Health Cigna Priority Health	$316.40
Rate for Payer: UMR Bronson Commercial	$207.92

PR LEVALBUTEROL NON-COMP UNIT

Professional

Both

$5.00

Service Code	HCPCS J7614
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$0.05
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50
Rate for Payer: UMR Bronson Commercial	$2.30

PR LEVONORGESTREL IMPLANT SYS

Professional

Both

$550.00

Service Code	HCPCS J7306
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$2,147.54
Rate for Payer: Aetna Commercial	$406.00
Rate for Payer: BCBS Complete	$220.00
Rate for Payer: BCBS Trust/PPO	$2,147.54
Rate for Payer: Cash Price	$440.00
Rate for Payer: Cash Price	$440.00
Rate for Payer: Priority Health Cigna Priority Health	$385.00
Rate for Payer: UMR Bronson Commercial	$253.00

PR LEVONORGESTREL IU CONTRACEPT

Professional

Both

$823.00

Service Code	HCPCS J7302
Min. Negotiated Rate	$329.20
Max. Negotiated Rate	$576.10
Rate for Payer: BCBS Complete	$329.20
Rate for Payer: Cash Price	$658.40
Rate for Payer: Priority Health Cigna Priority Health	$576.10
Rate for Payer: UMR Bronson Commercial	$378.58

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$485.00

Service Code	HCPCS 93452
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$1,383.09
Rate for Payer: Aetna Commercial	$1,229.14
Rate for Payer: BCBS Complete	$194.00
Rate for Payer: BCBS Trust/PPO	$1,383.09
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cash Price	$388.00
Rate for Payer: Priority Health Cigna Priority Health	$339.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$324.39
Rate for Payer: Priority Health Narrow Network	$324.39
Rate for Payer: Priority Health SBD	$1,276.74
Rate for Payer: UMR Bronson Commercial	$223.10

PR LIDOCAINE INJECTION

Professional

Both

$3.00

Service Code	HCPCS J2001
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$2.10
Rate for Payer: UMR Bronson Commercial	$1.38

PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR

Professional

Both

$2,440.00

Service Code	HCPCS 27427
Min. Negotiated Rate	$459.02
Max. Negotiated Rate	$1,708.00
Rate for Payer: Aetna Commercial	$951.25
Rate for Payer: BCBS Complete	$481.97
Rate for Payer: BCBS Trust/PPO	$1,194.49
Rate for Payer: Cash Price	$1,952.00
Rate for Payer: Cash Price	$1,952.00
Rate for Payer: Meridian Medicaid	$481.97
Rate for Payer: Priority Health Choice Medicaid	$459.02
Rate for Payer: Priority Health Cigna Priority Health	$1,708.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,093.29
Rate for Payer: Priority Health Narrow Network	$1,093.29
Rate for Payer: Priority Health SBD	$1,093.29
Rate for Payer: UMR Bronson Commercial	$1,122.40

PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR

Professional

Both

$3,183.00

Service Code	HCPCS 27428
Min. Negotiated Rate	$720.79
Max. Negotiated Rate	$2,228.10
Rate for Payer: Aetna Commercial	$1,488.41
Rate for Payer: BCBS Complete	$756.83
Rate for Payer: BCBS Trust/PPO	$1,728.07
Rate for Payer: Cash Price	$2,546.40
Rate for Payer: Cash Price	$2,546.40
Rate for Payer: Meridian Medicaid	$756.83
Rate for Payer: Priority Health Choice Medicaid	$720.79
Rate for Payer: Priority Health Cigna Priority Health	$2,228.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,712.73
Rate for Payer: Priority Health Narrow Network	$1,712.73
Rate for Payer: Priority Health SBD	$1,712.73
Rate for Payer: UMR Bronson Commercial	$1,464.18

PR LIGATION ARTERIES ETHMOIDAL

Professional

Both

$1,018.00

Service Code	HCPCS 30915
Min. Negotiated Rate	$388.94
Max. Negotiated Rate	$935.09
Rate for Payer: Aetna Commercial	$764.23
Rate for Payer: BCBS Complete	$408.39
Rate for Payer: BCBS Trust/PPO	$935.09
Rate for Payer: Cash Price	$814.40
Rate for Payer: Cash Price	$814.40
Rate for Payer: Meridian Medicaid	$408.39
Rate for Payer: Priority Health Choice Medicaid	$388.94
Rate for Payer: Priority Health Cigna Priority Health	$712.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$845.98
Rate for Payer: Priority Health Narrow Network	$845.98
Rate for Payer: Priority Health SBD	$845.98
Rate for Payer: UMR Bronson Commercial	$468.28

PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL

Professional

Both

$1,472.00

Service Code	HCPCS 30920
Min. Negotiated Rate	$561.04
Max. Negotiated Rate	$2,317.12
Rate for Payer: Aetna Commercial	$1,110.06
Rate for Payer: BCBS Complete	$589.09
Rate for Payer: BCBS Trust/PPO	$2,317.12
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Meridian Medicaid	$589.09
Rate for Payer: Priority Health Choice Medicaid	$561.04
Rate for Payer: Priority Health Cigna Priority Health	$1,030.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,223.37
Rate for Payer: Priority Health Narrow Network	$1,223.37
Rate for Payer: Priority Health SBD	$1,223.37
Rate for Payer: UMR Bronson Commercial	$677.12

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$882.00

Service Code	HCPCS 37609
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$911.85
Rate for Payer: Aetna Commercial	$272.71
Rate for Payer: BCBS Complete	$136.65
Rate for Payer: BCBS Trust/PPO	$911.85
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cash Price	$705.60
Rate for Payer: Meridian Medicaid	$136.65
Rate for Payer: Priority Health Choice Medicaid	$130.14
Rate for Payer: Priority Health Cigna Priority Health	$617.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$324.49
Rate for Payer: Priority Health Narrow Network	$324.49
Rate for Payer: Priority Health SBD	$324.49
Rate for Payer: UMR Bronson Commercial	$405.72

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$882.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$200.07
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna American Axle	$573.30
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna Medicare	$1,498.78
Rate for Payer: Aetna New Business (MI Preferred)	$573.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,801.41
Rate for Payer: Amish Plain Church Group Commercial	$1,801.41
Rate for Payer: BCBS Complete	$827.79
Rate for Payer: BCBS MAPPO	$1,441.13
Rate for Payer: BCBS Trust/PPO	$2,700.99
Rate for Payer: BCN Medicare Advantage	$1,441.13
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cofinity Commercial	$617.40
Rate for Payer: Cofinity Commercial	$758.52
Rate for Payer: Encore Health Key Benefits Commercial	$705.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,441.13
Rate for Payer: Healthscope Commercial	$793.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$617.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$661.50
Rate for Payer: Mclaren Medicaid	$788.30
Rate for Payer: Mclaren Medicare	$1,441.13
Rate for Payer: Meridian Medicaid	$827.79
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,513.19
Rate for Payer: MI Amish Medical Board Commercial	$1,657.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$749.70
Rate for Payer: PACE Medicare	$1,369.07
Rate for Payer: PACE SWMI	$1,441.13
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: PHP Medicare Advantage	$1,441.13
Rate for Payer: Priority Health Choice Medicaid	$788.30
Rate for Payer: Priority Health Cigna Priority Health	$617.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,441.13
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Priority Health SBD	$555.66
Rate for Payer: Railroad Medicare Medicare	$1,441.13
Rate for Payer: UHC All Payor (Choice/PPO)	$220.08
Rate for Payer: UHC Dual Complete DSNP	$1,441.13
Rate for Payer: UHC Exchange	$200.07
Rate for Payer: UHC Medicare Advantage	$1,484.36
Rate for Payer: UMR Bronson Commercial	$326.34
Rate for Payer: VA VA	$1,441.13
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$661.50

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$882.00

Service Code	HCPCS 37609
Hospital Charge Code	37609
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$911.85
Rate for Payer: Aetna Commercial	$272.71
Rate for Payer: BCBS Complete	$136.65
Rate for Payer: BCBS Trust/PPO	$911.85
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cash Price	$705.60
Rate for Payer: Meridian Medicaid	$136.65
Rate for Payer: Priority Health Choice Medicaid	$130.14
Rate for Payer: Priority Health Cigna Priority Health	$617.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$324.49
Rate for Payer: Priority Health Narrow Network	$324.49
Rate for Payer: Priority Health SBD	$324.49
Rate for Payer: UMR Bronson Commercial	$405.72

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$882.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$388.08
Max. Negotiated Rate	$793.80
Rate for Payer: Aetna American Axle	$573.30
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna New Business (MI Preferred)	$573.30
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cofinity Commercial	$617.40
Rate for Payer: Cofinity Commercial	$758.52
Rate for Payer: Encore Health Key Benefits Commercial	$705.60
Rate for Payer: Healthscope Commercial	$793.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$617.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$661.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$749.70
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: Priority Health Cigna Priority Health	$617.40
Rate for Payer: Priority Health SBD	$555.66
Rate for Payer: UMR Bronson Commercial	$388.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$661.50

PR LIGATION DIRECT ESOPHAGEAL VARICES

Professional

Both

$3,073.00

Service Code	HCPCS 43400
Min. Negotiated Rate	$972.56
Max. Negotiated Rate	$2,672.92
Rate for Payer: Aetna Commercial	$2,061.51
Rate for Payer: BCBS Complete	$1,021.19
Rate for Payer: BCBS Trust/PPO	$986.56
Rate for Payer: Cash Price	$2,458.40
Rate for Payer: Cash Price	$2,458.40
Rate for Payer: Meridian Medicaid	$1,021.19
Rate for Payer: Priority Health Choice Medicaid	$972.56
Rate for Payer: Priority Health Cigna Priority Health	$2,151.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,672.92
Rate for Payer: Priority Health Narrow Network	$2,672.92
Rate for Payer: Priority Health SBD	$2,672.92
Rate for Payer: UMR Bronson Commercial	$1,413.58

PR LIGATION HEMORRHOID BUNDLE W/US

Professional

Both

$2,050.00

Service Code	HCPCS 0249T
Min. Negotiated Rate	$820.00
Max. Negotiated Rate	$1,435.00
Rate for Payer: BCBS Complete	$820.00
Rate for Payer: Cash Price	$1,640.00
Rate for Payer: Priority Health Cigna Priority Health	$1,435.00
Rate for Payer: UMR Bronson Commercial	$943.00

PR LIGATION INTERNAL/COMMON CAROTID ARTERY

Professional

Both

$1,957.00

Service Code	HCPCS 37605
Min. Negotiated Rate	$462.42
Max. Negotiated Rate	$1,369.90
Rate for Payer: Aetna Commercial	$991.38
Rate for Payer: BCBS Complete	$485.54
Rate for Payer: BCBS Trust/PPO	$1,342.94
Rate for Payer: Cash Price	$1,565.60
Rate for Payer: Cash Price	$1,565.60
Rate for Payer: Meridian Medicaid	$485.54
Rate for Payer: Priority Health Choice Medicaid	$462.42
Rate for Payer: Priority Health Cigna Priority Health	$1,369.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,148.49
Rate for Payer: Priority Health Narrow Network	$1,148.49
Rate for Payer: Priority Health SBD	$1,148.49
Rate for Payer: UMR Bronson Commercial	$900.22

PR LIGATION MAJOR ARTERY ABDOMEN

Professional

Both

$3,207.00

Service Code	HCPCS 37617
Min. Negotiated Rate	$837.30
Max. Negotiated Rate	$2,244.90
Rate for Payer: Aetna Commercial	$1,785.58
Rate for Payer: BCBS Complete	$879.16
Rate for Payer: BCBS Trust/PPO	$999.54
Rate for Payer: Cash Price	$2,565.60
Rate for Payer: Cash Price	$2,565.60
Rate for Payer: Meridian Medicaid	$879.16
Rate for Payer: Priority Health Choice Medicaid	$837.30
Rate for Payer: Priority Health Cigna Priority Health	$2,244.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,071.45
Rate for Payer: Priority Health Narrow Network	$2,071.45
Rate for Payer: Priority Health SBD	$2,071.45
Rate for Payer: UMR Bronson Commercial	$1,475.22

PR LIGATION MAJOR ARTERY CHEST

Professional

Both

$3,321.00

Service Code	HCPCS 37616
Min. Negotiated Rate	$713.55
Max. Negotiated Rate	$2,324.70
Rate for Payer: Aetna Commercial	$1,477.32
Rate for Payer: BCBS Complete	$749.23
Rate for Payer: BCBS Trust/PPO	$1,012.22
Rate for Payer: Cash Price	$2,656.80
Rate for Payer: Cash Price	$2,656.80
Rate for Payer: Meridian Medicaid	$749.23
Rate for Payer: Priority Health Choice Medicaid	$713.55
Rate for Payer: Priority Health Cigna Priority Health	$2,324.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,740.03
Rate for Payer: Priority Health Narrow Network	$1,740.03
Rate for Payer: Priority Health SBD	$1,740.03
Rate for Payer: UMR Bronson Commercial	$1,527.66

PR LIGATION MAJOR ARTERY EXTREMITY

Professional

Both

$1,055.00

Service Code	HCPCS 37618
Min. Negotiated Rate	$249.85
Max. Negotiated Rate	$848.45
Rate for Payer: Aetna Commercial	$521.95
Rate for Payer: BCBS Complete	$262.34
Rate for Payer: BCBS Trust/PPO	$848.45
Rate for Payer: Cash Price	$844.00
Rate for Payer: Cash Price	$844.00
Rate for Payer: Meridian Medicaid	$262.34
Rate for Payer: Priority Health Choice Medicaid	$249.85
Rate for Payer: Priority Health Cigna Priority Health	$738.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$615.47
Rate for Payer: Priority Health Narrow Network	$615.47
Rate for Payer: Priority Health SBD	$615.47
Rate for Payer: UMR Bronson Commercial	$485.30

Know your out-of-pocket cost for care.

All Charges